What is Ovarian Cancer (Adenocarcinoma of the Ovary)?

Ovarian cancer refers to cancer of the cells of the ovary. The ovaries are the organs which produce eggs for fertilization and subsequent reproduction. They also produce hormones which regulate the menstrual cycle.

About 90% of ovarian cancer arises from the cells on the outer surface of the ovary.

Statistics

Ovarian cancer accounts for about 3-4% of cancer in women. It is commonest in women between 60 and 70 years of age. It is the 8th most common cancer diagnosed in Australian women, and the 6th most common cause of cancer death in Australian women.

Transabdominal ultrasound requires a full bladder to visualise the ovaries.

Prognosis

The outcome of disease depends on the extent of the disease. If found early before the cancer spreads to surrounding organs, the disease can be successfully treated. Approximately half of women diagnosed with ovarian cancer will survive at least 5 years.

Treatment

The type of treatment depends on the stage of the disease. First-line treatment is surgical management, followed by chemotherapy then radiotherapy.

Surgical management

Surgical management is done by open surgery. This is to assess the stage of disease as well as remove the tumour. Removal of the tumour may involve removal of the ovaries, uterus and cervix, and other organs that it may have spread to. The removed specimen is sent to the laboratory to stage the disease for appropriate treatment.

Bowel preparation may be required before surgery. If the cancer has spread to the bowel, a bowel resection may be necessary. Studies have shown that the less disease left after surgery, the longer the survival time.

For young women with early disease, the uterus and the unaffected ovary may be preserved for future reproduction. This would require a careful follow-up program.

Chemotherapy

Chemotherapy in ovarian cancer prolongs short term survival and improves quality of life. It increases the 5-year survival rate from 74% to 82% in some patients with early stage disease. Chemotherapy also reduces the risk of recurrences and death in early disease if the surgery did not remove all of the disease.

Chemotherapy uses a combination of drugs to kill cancer cells and slow their growth. These drugs are listed below. The side-effects of some of these drugs will be explained by your doctors, and can usually be managed effectively by them. The therapy is usually recommended for around 6 cycles to achieve complete response.

In cases where surgery and chemotherapy have been unsuccessful, or where patient cannot withstand major surgery, they may be managed with palliative care. This aims to increase quality of life for the patient and family. Palliative management involves treating symptoms such as pain, nausea and bleeding, and symptoms of intestinal obstruction, as well as catering for social, psychological and spiritual needs.